China Perspectives

2009/1 | 2009 Chinese Society Confronted with AIDS

The Transnational Origin of a Local Response to HIV/AIDS in Henan Province

Vincent Rollet

Electronic version URL: http://journals.openedition.org/chinaperspectives/4769 DOI: 10.4000/chinaperspectives.4769 ISSN: 1996-4617

Publisher Centre d'étude français sur la Chine contemporaine

Printed version Date of publication: 1 April 2009 Number of pages: 17-28 ISSN: 2070-3449

Electronic reference Vincent Rollet, « The Transnational Origin of a Local Response to HIV/AIDS in Henan Province », China Perspectives [Online], 2009/1 | 2009, Online since 01 April 2011, connection on 28 October 2019. URL : http://journals.openedition.org/chinaperspectives/4769 ; DOI : 10.4000/chinaperspectives.4769

© All rights reserved Special feature s e

The Transnational Origin of v i a t c n i a Local Response to e h p s c HIV/AIDS in Henan r e Province p

VINCENT ROLLET

For several years now, at a time when Henan remains one of the areas of China most heavily affected by the HIV/AIDS virus, peasants in several of the worst affected villages have supplemented the official policies and strategic approaches to deal with its spread by progressively mobilising and organising their own local measures to deal with the social challenges that AIDS imposes on rural communities. This article is particularly concerned with the transnational origin behind this local mobilisation.

The social, political, and ics, or even beyond, without any testing for the presence of epidemiological context of the HIV. mobilisation Despite the fact that the presence of HIV in the blood col - lected in this way was discovered by the Henan authorities The commercial blood collections at the in 1995, and the villagers themselves were astonished at the source of the epidemic increasing number of deaths and illnesses around them (some even questioning local officials about the prevalence In the 1980s and 1990s, many villagers in Henan Province of this “unknown” disease (3) ), the provincial and local au - as well as other provinces (Anhui, Hubei, Hebei et al. ), thorities decided to conceal the truth, and knowingly contin - under the twin pressures of poverty and official exhortation, ued with the profitable trade in blood at the expense of the sold their blood at collection points organised by the local health of millions of Chinese. authorities. (1) These authorities, who paid them 50 yuan for In 1996, Gao Yaojie, a gynaecologist working in a hospital each donation, viewed such measures as a way of enriching in Zhenzhou, the provincial capital of Henan, discovered the peasants while also meeting the need for blood, the im - HIV in a peasant woman who had given blood several years portation of which had been forbidden since 1985, largely earlier at a rural collection point. Aware that this case repre - out of fear of HIV. (2) Massive numbers of poor villagers sented the tip of an iceberg, Dr. Gao decided to launch a turned out to give their blood several times a week in ex - preventive campaign at her own expense, using explanatory change for a pittance that enabled them to feed their fami - lies, pay their taxes, or provide for their children’s education. * The author thanks the members of the Taiwanese NGO Harmony Home as well as However, these blood collections were carried out under the peasants of the various villages in Henan Province where the field survey was carried out. He also extends his thanks to Evelyne Micollier, who invited him to join minimal sanitary conditions. The syringes were reused, there the IRD-PUMC/CAMS project. was no system for tracing the blood bags, and when all the 1. See in particular Pierre Haski, Le sang de la Chine, Quand le silence tue , Grasset blood had been mixed together and put through a centrifuge & Fasquelle, Paris, 2005, 228 pp. to extract the plasma, it was re-injected into the donors. This 2. “China Bans Import of Blood Products,” Xinhua , 3 September 1985. 3. Based on an interview with Mr. Lin, a villager from Shenqiu County, Henan blood was then sold on to the provincial hospitals and clin - Province, 20 June 2007.

17 N o 2009/1 Special feature s e v i a t leaflets and a book that she compiled, in order to inform as 1995, there had been 6,524 officially registered cases of c n i

e many Henan residents as possible of the risks they were run - HIV, out of which 1,940 had developed into AIDS. Yet h p ning through their paid blood donations. At the same time, in 2003, when it was clear that the whole of China had s c r she also gave financial support to several villagers and or - been affected by the trade in blood, (10) some experts in e (4) p phans affected by the disease. Yet the Henan authorities epidemiology estimated that there were actually 35,000 maintained their silence, denying the presence of AIDS in people in Henan who had tested positive. (11) In 2004, the their province, and trying by all possible means to prevent central health authorities declared that they had diag - Dr. Gao and her team of helpers from continuing with their nosed 16,000 HIV cases in Henan, but they also ac - preventive work in Henan, and specially from mentioning knowledged that this represented a minimum number, the situation in public. (5) since many blood donors had not been traced. (12) In the It was particularly after the year 2000 that a certain amount same year the reality of this situation was confirmed by a of information about the HIV/AIDS situation in Henan study concluding that 25,036 people in Henan had con - Province came to light. In October of that year, Dr. Gui tracted HIV, and that 11,815 of them had gone on to de - Xian revealed that out of the 155 blood samples he had se - velop AIDS. It also established that, depending on the cretly collected in Shangcai County, where the sale of blood county concerned, between 8 percent and 20 percent of had become commonplace, 65 percent had tested positive those who had sold their blood had been infected. (13) In for HIV. Also, China News Weekly revealed that in several 2005, following a huge official tracing exercise among villages in that county there were families who had lost mem - Henan’s 100 million inhabitants, the Chinese Ministry of bers to AIDS. For its part, the international press revealed Health registered 29,337 cases of HIV, which included that a doctor from Beijing, who had inspected a number of 16,456 cases of AIDS. Out of those who tested positive, rural hospitals in Henan without permission, had discovered 90 percent were former blood donors and 98 percent were an abnormally high number of HIV infections, (6) and that peasants. (14) By the end of 2006, according to the Chinese the village of Wenlou in Shangcai County had experienced government, the number of HIV cases in Henan stood at 800 deaths from AIDS in two years. (7) 35,232, out of whom 21,828 had AIDS and 75 percent International governmental organisations and NGOs, as well had given blood at least once. (15) as some prominent figures in Chinese medical circles and Yet these figures are in reality vast under-estimates, largely other concerned groups, paid close attention and alerted the because of the extreme difficulty in carrying out tracing central and provincial authorities to the urgent need to re - procedures among the peasants in Henan. Given the wide spond to the situation in Henan if they did not wish to face an HIV/AIDS epidemic spreading throughout the whole of 4. Gao Yaojie, “My AIDS journey,” available at http://www.org/Chindoc/gao_jrny.htm. (con - China. At the beginning of August 2001, in order to clarify sulted on 4 January 2009). Gao Yaojie gave out 300,000 copies of her book, The pre - vention and treatment of AIDS and venereal diseases , and 610,000 copies of her leaflet the situation in Henan, the central government sent in a “How to protect against AIDS.” She was awarded the Jonathan Mann prize for Global team from its working group on the prevention and treatment Health and Human Rights in 2001. of HIV/AIDS. They concluded that “illegal” blood collec - 5. According to an interview with Dr. Gao in Zhengzhou, Henan, May 2006. 6. Elizabeth Rosenthal, “In Rural China, a Steep Price of Poverty: Dying of AIDS,” The New tion centres were the main source of the widespread propa - York Times , 28 October 2000, p. A1. (8) gation of HIV among paid blood donors. A few weeks 7. “Chinese Villages ‘Devoured’ by AIDS: Locals Ordered to Keep Silent,” Agence France later the Ministry of Health officially acknowledged, for the Presse, 30 November 2000. first time, that villagers from some provinces in central China 8. “Illegal Blood Trade Contributed to Rural HIV Epidemic,” Renmin Ribao , 9 August 2001, p. 6. had been infected by HIV after selling their blood in the col - 9. “PRC Health Ministry Official: China to Act Sternly against Illegal Blood Deals,” Xinhua , lection centres, and that drastic measures needed to be taken 23 August 2001. against the trade. (9) 10. State Council HIV/AIDS Working Committee Office and UN Theme Group on HIV/AIDS in China (2004), A Joint Assessment of HIV/AIDS Prevention, Treatment and Care in China , 1 December 2004. The extent of HIV infection in Henan and 11. “HIV carriers in Henan estimated at 35,000,” China Daily , 17 November 2003. its social consequences 12. “More HIV cases expected in Henan,” China Daily , 29 June 2004. This under-estimation could be explained by the example of the town of Zhumadian (Henan), where only 30,000 of the 74,800 former blood donors were traced. Whereas in 2001 the central authorities had very little in - 13. “Survey finds 20,000 more HIV carriers,” China Daily , 16 November 2004. formation about the spread of HIV/AIDS in Henan, in 14. “Henan gets it right in war on HIV/AIDS,” China Daily , 4 November 2005. 2002 they stated that since its discovery in the province in 15. “Illegal blood trade main cause of AIDS in Henan,” Shanghai Daily , 13 March 2007.

18 N o 2009/1 Tombs of villagers who died of AIDS, Henan Province © Vincent Rollet s e v i a extent of the blood trade and the length of time in which t c n i the risk of HIV infection was concealed from donors and e h recipients, a far more probable estimate of the number of p s c infected people in the province would seem to be between r e (16) 370,000 and 1 million, a figure proposed by some Chi - p nese epidemiologists in 2002 and supported by the WHO at the time of their visit in 2003. (17) Although it is still dif - ficult to assess the exact extent of HIV infection in Henan, there are many who recognise that the official Chinese sta - tistics are very far from reflecting the true level of infection in the province. Here I would just take from the official sta - dictate, to other close relatives, or are simply left to fend tistics the decline (from 90 percent to 75 percent) in the for themselves. In any event, they are deprived of the proportion of blood donors among all those who tested pos - overall sense of family support with which they were itive in Henan between 2005 and 2006. This trend clearly raised. shows that since 2006 HIV has no longer been restricted For the Henan peasants who have tested positive, or to blood donors but has started to spread among the gen - whose relatives are carriers, HIV/AIDS becomes synony - eral population, while remaining concentrated in the rural mous with increased levels of poverty, because the sick - areas (90 percent) and mainly among native inhabitants ness of a family member has a direct impact on a peasant aged between 30 and 50 (70 percent). (18) family’s income and food stock. Anyone badly affected by But beyond the statistical data, HIV/AIDS remains above the infection no longer has the strength to work the land all a personal disaster for tens of thousands of peasants and as efficiently as before, while taking up time and effort their families, whose life even before the AIDS epidemic that his or her partner then needs to spend on double the was already extremely hard in many respects (such as amount of work. Consequently, the productivity of the poverty, very restricted access to primary health care, family plot goes into steep decline, causing both loss of scarcely any civil rights, etc.). Three main consequences revenue and diminishing food stock. This forces the fam - related to the epidemic have quickly come to light: far- ily to sell some of its animals, not only to meet the imme - reaching family break-up, increasing levels of impoverish - diate need for food but also to buy medicine for the sick ment, and a far higher level of social discrimination. family member. This drop in family income also has a di - By infecting or killing one or even several members of a rect impact on the grandparents’ living standards, particu - family, the HIV/AIDS outbreak has profoundly dis - larly in the case of the very old who depend on a child’s rupted the family unit, which normally consists of grand - support to survive. That is why the links between AIDS parents, parents, and a single child. This disruption of the and poverty has turned out to be particularly marked in family structure is particularly serious when both parents Henan. While it was poverty that led men and women are at an advanced stage of AIDS, or when it has killed alike to sell their blood in the first place, the HIV/AIDS them, or when the surviving parent decides to migrate in outbreak has caused a further impoverishment of those search of work. In these circumstances, it is the child and peasant families struck down by it. the grandparents, if they are still alive, who bear the Finally, the spread of HIV/AIDS throughout Henan has brunt of the disease. Grandparents are left taking care of also become synonymous with discrimination against its their sick child or his offspring, if the former has died, peasantry, and especially against those from the counties which means they can no longer rely on financial and ma - and villages worst affected by the virus. This discrimina - terial support from their own child, and that they must re - tion operates at every level and in many different areas of turn to work to support both him/her and the grandchil - daily life (such as hospitals, schools, public services, mar - dren. In this way, HIV/AIDS threatens to undermine kets, etc.). the whole organisation of peasant family life, structured as it is around the filial piety that plays such a major role 16. “Workers’ Daily Says 80 Percent of Henan Village Ravaged by HIV,” South China Morn - in the life and well-being of the older generation. As for ing Post , 4 January 2002. 17. “AIDS Patients Denied Access to Visiting WHO Team, Beaten by Police,” South China the orphans left by one or both of their parents, they are Morning Post , 3 June 2003. entrusted to their grandparents or, when circumstances 18. “Illegal blood trade main cause of AIDS in Henan,” China Daily , 13 March 2007.

19 N o 2009/1 Special feature

This house in Henan Province was abandoned after some of its occupants were infected by HIV. © Vincent Rollet s e v i a t The response of the central government c n i e and local authorities in Henan h p s c r When AIDS first appeared in China, the authorities consid - e

p ered it to be a “foreigners’ disease,” and then a “social curse” linked to capitalism or immoral conduct. As a conse - quence of these perceptions, early official responses were punitive and discriminatory. From 1998 onwards, recognis - ing that their measures had been ineffective, the central au - thorities launched two national action plans (19) and a pilot the tests blood bags and blood products must undergo before scheme (20) to deal with the ongoing increase in HIV/AIDS they can be used by hospitals and clinics. It also laid down infections. However, these measures were largely hampered a number of measures to improve standards in the storage by low budgetary commitments, insufficient attention by the and transport of blood, and in the tracing of blood products. central government, and a lack of co-ordination between the Likewise in 2007, in order to strengthen supervision and im - various ministries. (21) prove control over blood and plasma collection centres and This situation did not change until 2002-2003. Then, partly over the units making blood products, the central health au - as a consequence of the international community’s increas - thorities introduced the “Protocol on the national consolida - ing awareness of both the HIV/AIDS situation in China tion against the illegal collection of plasma and blood,” (26) (especially after the revelation in 2001 of the blood contam - which they urged provincial and local authorities to adopt. ination in Henan) and of the weaknesses of the Chinese This was further strengthened in 2008 by the addition of fur - health system revealed by the SARS crisis, but also as a re - ther regulations that delegated power to provincial authori - sult of the accession of a new generation of Chinese policy- ties to issue building permits for collection centres in their re - makers to positions of power, the official approach to the gion, to upgrade the equipment, recruitment, and training of HIV/AIDS problem finally underwent a genuine transfor - technical staff, and to make it mandatory for all blood donors mation. (22) Among the measures taken by the Chinese gov - to undergo health checks. (27) Thanks to these various meas - ernment in response to HIV/AIDS, two sorts specifically ures, the proportion of voluntary donors is reported to have target the situation in Henan: those aimed at controlling the risen from 5.5 percent in the late 1990s to 95 percent in spread of the virus among peasants, and those providing a medical and social response to the consequences of the dis - 19. A medium and long term plan for the prevention and control of HIV/AIDS and Sexually ease for individuals and families. Transmitted Diseases (STDs) (1998-2010) , the main aims of which were 1) to promote With regard to the application in Henan Province of the education about these diseases, 2) to provide care to those living with the infection and to support their families, and 3) to strengthen the control over the quality of blood prod - government’s measures for controlling the spread of HIV in ucts; and An action plan to contain and control the HIV/AIDS (2001-2005) , which em - the countryside, the principal initiatives have been those phasised the urgent need for strategies dependent on 1) promoting the use of condoms, 2) the controlled supply of methadone, and 3) the provision of clean syringes for intra - aimed at improving the blood collection and distribution venous drug users. processes, which since 1998 have normally been covered by 20. A Pilot scheme to provide care and treatment to people living with HIV/AIDS , which was the Blood Donations Law. (23) The enforcement of higher mounted in 100 counties beginning in October 2002. 21. On a certain number of sensitive issues, the lack of consensus between the different ad - standards in these systems of blood collection and manage - ministrative branches was plainly visible. For example there was a deep disagreement ment was initiated in 2002 with the closure of hundreds of between ministries over the issue of generic production of antiretroviral drugs. This set collection centres that failed to comply with the 1998 law, its supporter, the Ministry of Health, against the ministries of Foreign Affairs and Over - seas Trade, which considered it a threat to the country’s reputation among foreign in - the arrest of their organisers, the destruction of contami - vestors, and a derogation from China’s commitments as a member of the WTO. nated blood stocks publicised in the media, and by a policy 22. Zunyou Wu et al. , “Evolution of China’s response to HIV/AIDS,” The Lancet , 24 February of central and provincial government investment totalling 2007. 23. Available at : http://www.chain.net.cn/english//document/20080312173431009 2.25 billion yuan in 2003, intended for a nation-wide re - 832.pdf. building of such centres in accordance with proper stan - 24. “Blood quality top concern of medical workers,” China Daily , 19 October 2004. dards. (24) 25. PRC Ministry of Health Order No. 44, 1 March 2006. In March 2006, the Health Minister had the “Blood Station 26. State Council AIDS Working Committee Office, UN Theme Group on AIDS in China, A Joint (25) Assessment of HIV/AIDS Prevention, Treatment and Care in China (2007) , 1 December Management Law” passed, which had the merit of stan - 2007, p. 23. dardising all blood collections in the centres and spelling out 27. “Blood collection rules tightened,” China Daily , 1 March 2008.

20 N o 2009/1 The Transnational Origin of a Local Response to HIV/AIDS in Henan Province s e v i a 2007, and the reported percentage of blood from unpaid vol - directly, in China as elsewhere, on the implementation of t c n i unteers used by hospitals and clinics rose from 22 percent in national strategies at the provincial and local levels. e h 1998 to 85 percent in 2004, (28) 91.3 percent in 2005, (29) and In Henan, the provincial authorities have taken an ambigu - p s c 98 percent in 2007. (30) ous approach towards the policy directives from the centre. r e

In parallel with these measures for controlling the infection, Admittedly, the Henan authorities did implement the cen - p which were particularly relevant to Henan Province, the au - tral directives on the struggle against HIV/AIDS in some thorities also put forward several strategies to confront the so - counties, but at the same time, taking advantage of the au - cial challenges posed by HIV/AIDS in the countryside, in - tonomy they gained from the decentralisation of 1979, they cluding the province of Henan. Among the most important imposed restrictions on information about the disease, and of these we would highlight the so-called “Four Frees and adopted a policy of repressing all the social forces demand - One Care” strategy ( si mian yi guan huai ), which the govern - ing improvements to those initiatives. According to some of - ment launched in 2003. This national programme called for ficials, such people represented a threat. With regard to the the free provision of 1) antiretroviral treatment for those who implementation of the national strategies within the have tested positive, whether they are rural or urban resi - province, we should take particularly note of those con - dents, and who face financial difficulties, 2) tracing and coun - cerned with improving the procedures for collecting and selling services, 3) antiretroviral treatment for pregnant managing blood supplies. Since 2003 the Henan authorities women who have tested positive, and the tracking of their have come down heavily on collection centres that do not fol - newly born children, and 4) access to education for AIDS or - low the rules, and they have opened new centres that do phans. It also covered the provision of care required by peo - comply and have properly qualified staff. They have also ple living with HIV/AIDS, along with financial support for taken steps to promote the use of non-commercial blood do - their families. In February 2006, the State Council incorpo - nations in hospitals and clinics. As a result, in 2004 the rated this strategy into its overall action plan for combating Medical Policy Office of the Ministry of Health reported HIV/AIDS in China, known as China’s Action Plan for that 100 percent of the blood used in its establishments in Reducing and Preventing the Spread of HIV/AIDS (2006- Henan consisted of unpaid donations. (33) 2010) . (31) This gives clear policy directives to provide support The Henan authorities have also attempted to implement for peasant families affected by HIV/AIDS. The “Four the national “Four Frees and One Care” strategy. In Febru - Frees and One Care” programme has been supplemented by ary 2004, (34) the provincial government sent 76 officials, in - several other official campaigns initiated by certain ministers creased to 114 in March 2005, (35) to 38 villages to detect to reinforce the existing response to the challenge posed by HIV infections free of charge, to supply antiretroviral treat - HIV/AIDS in the Chinese countryside, particularly in ment to peasants who tested positive (amounting to 6,700 in Henan. For example, in March 2006, the Ministry of Civil 2005), and to provide support and care to AIDS orphans. Affairs published a series of “Suggestions for improving the Henan has also provided investment to build clinics in a cer - aid to orphans,” emphasising the need to build orphanages tain number of villages so as to provide care near the homes and improve the living conditions of such children. of peasants infected with HIV, as well as orphanages to shel - While the drawing-up of national policies backed by a gen - ter children who have lost their parents to AIDS. (36) The uine willingness on the part of the government represents first official orphanage in Henan was built on two hectares only a first step on the road to an effective response to HIV/AIDS, it cannot be denied, in view of the national ac - 28. “Blood quality top concern of medical workers,” China Daily , 19 October 2004. 29. “Search for regular and willing blood donors,” China Daily , 16 March 2005. tion plans set out by the Chinese government to meet the 30. State Council AIDS Working Committee Office, UN Theme Group on AIDS in China, A Joint challenges of this disease in the countryside, that since 2003 Assessment of HIV/AIDS Prevention, Treatment and Care in China (2007) , 1 December China has passed this first hurdle, and that the central au - 2007, p. 23. 31. State Council Office Document (2006), No. 13, 27 February 2006. This plan also pro - thorities have become fully aware of the gravity of the situa - vided for a vast increase in syringe exchange programmes, the training of medical per - tion, and of the need to act swiftly and decisively. As Peter sonnel and officials in charge of policy, strengthening quality control over blood prod - Piot, the UNAIDS chief, stated clearly in 2007, “The cen - ucts, and improving the systems for supervision and the provision of care. tral government leadership and the national policies are prac - 32. “UNAIDS chief praises China’s anti-AIDS efforts,” China Daily , 17 July 2007. 33. “Blood quality top concern of medical workers,” China Daily , 19 October 2004. (32) tically as good as they could possibly be.” However, the 34. “Henan provides lesson in fight against AIDS,” China Daily , 18 February 2004. effectiveness of the struggle against HIV/AIDS, and of the 35. “HIV/AIDS villagers get health treatment,” China Daily , 21 April 2005 aid given to those affected in particular, is going to depend 36. “Help coming in for AIDS orphans,” China Daily , 9 June 2004.

21 N o 2009/1 Special feature s e v i a t of land in the village of Wenlou (Shangcai), which was es - visits by Chinese and foreign officials, particularly to Shang - c n

i (37)

e pecially badly hit by HIV. cai County, are all tightly controlled by the local authorities h p In April 2004, the Poverty Reduction Office, the Depart - to prevent the release of any information that might differ s c r ment of Civil Affairs, and the Henan Finance Office issued from official statements. (42) e

p a joint document that set out standardised procedures and The most recent example of the Henan authorities’ obstinate strengthened the support for AIDS orphans and for the eld - desire to limit the information about the HIV outbreak is the erly living alone as a result of AIDS in their family. (38) This physical violence and robbery inflicted on two Belgian journal - document, which was inspired by the “Four Frees and One ists in November 2008 (43) as they were making a documentary Care” strategy, restated that the orphans must have free ac - about AIDS in Henan. In other cases too, the Henan author - cess to education and that the elderly had a right to financial ities have tried to muzzle, mostly by repressive means, any support. The ceiling for the monthly payments was set at move that they interpret as questioning their actions (or uncov - 180 yuan for orphans under 18 years of age, and at 160 ering their inaction) in the fight against HIV/AIDS. A par - yuan for the elderly over 60, with 240 yuan per year added ticularly striking example among many of this official repres - to cover medical costs. Adopted children were to receive 130 sion is the large-scale raid in June 2003 by a force of 500 po - yuan per month. Eighty per cent of this assistance was to licemen on the village of Xiongqiao in Shangcai (where 24 come from provincial government funds. percent of the inhabitant were infected with HIV), and the While undertaking these official initiatives, the provincial arrest of 16 infected farmers who were accused of attacking and local authorities in Henan are still very careful to main - local government, police, and Party offices when they called tain control over information concerning the true extent of for a clinic to be built in their village. (44) There was a similar the HIV/AIDS problem in their region, and the methods occurrence in July 2004, with the arrest of four HIV-positive used in their struggle against it. Indeed, after having denied people from Henan who had decided to go to Beijing to peti - the presence of HIV in Henan until 2002, the authorities tion the central authorities about the lack of the promised an - there are still practising a policy of withholding information tiretroviral treatment and the banning of their children from at - and of repression against all the social forces (such as in - tending school. (45) The list of these repressive acts in Henan fected peasants, associations, activists, journalists, etc.) who is long and continues to grow. might question the reality or the appropriateness of the au - Finally, if the Henan authorities until now have been ex - thorities’ activity in the struggle against HIV/AIDS. Up to tremely vigilant against the activities of certain Chinese as - the present, the practical application of this twin policy has sociations and activists struggling against the social conse - been to control access to the most infected villages (particu - quences of HIV/AIDS in the province, they have openly larly in the counties of Shangcai and Shenqiu), and its main forbidden entry to international NGOs trying to contribute objective has been to prevent journalists, researchers, and medical and social assistance in that area, such as Médecins Chinese and foreign activists from getting hold of any infor - Sans Frontières in 2006. (46) mation not supplied by the provincial authorities concerning the progress of the disease among the peasant population 37. “Official AIDS orphanage to debut in China,” China Daily , 16 June 2004. and the real living conditions of those infected and their fam - 38. “Assistance for AIDS orphans highlighted in Henan,” China Daily , 10 April 2004. ilies. In other words, no information on the HIV/AIDS sit - 39. “PRC Health Official Arrested for Leaking AIDS Secrets,” Agence France Presse, 19 August 2003. uation in Henan can come from the villages, the counties, or 40. “Chinese Health Official Sentenced to Prison for Leaking AIDS ‘Secrets,’” Agence France the province except through official channels. Presse, 6 October 2003. This control over information is particularly apparent in the 41. “China Frees AIDS Official,” Financial Times , 20 October 2003, p. 5. response of the Henan authorities to those whom it consid - 42. “AIDS Patients Denied Access to Visiting WHO Team, Beaten by Police,” South China ers a threat. For example, in August 2003, the Assistant Di - Morning Post , 3 June 2003. 43. “A VRT team attacked in China,” Le Soir , 29 November 2008. rector of the Henan CDC, Ma Shiwen, was arrested and ac - 44. “Hundreds of Police Storm ‘AIDS’ village in China, Arrest 13 Farmers,” Agence France cused of betraying “State Secrets” because he shared infor - Presse, 3 July 2003; “Several Villagers Detained in China AIDS Raid Formally Arrested,” mation on the spread of the contagion in his province with Agence France Presse, 28 July 2003. (39) 45. “China Detains Four HIV Positive People Asking for Help,” Agence France Presse, 15 July an unofficial association. He faced a ten-year prison sen - 2004. (40) tence but was released three months later, a few days 46. In June 2006, the Henan provincial authorities refused entry to an MSF team which had after a visit to China by the American Secretary of State for been negotiating for four years to set up an AIDS treatment programme there. See Médecins Sans Frontières, “MSF team frustrated about closed doors in China,” 22 June (41) Health, Tommy Thompson. Ma has since confirmed that 2006, available at www.msf.org.

22 N o 2009/1 The Transnational Origin of a Local Response to HIV/AIDS in Henan Province s e v i a Consequently, although the Henan authorities have been homeless or who need temporary shelter, (49) and also pro - t c n

(50) i trying since 2003 to show the central and overseas govern - vides care or assistance in finding work. In general this e h ments, as well as the international organisations, that their help is provided with maximum discretion, largely because p s c province has finally become fully committed to the fight of the persistent discrimination against HIV carriers in Tai - r e (51) against HIV/AIDS by following the directives laid down in wan. Inscribed at the heart of Harmony Home’s commit - p the national plans, the fact is that because of their absolute ment is the principle of greater involvement of the people af - control of information, their tight restrictions on access to fected by HIV themselves, (52) expressed by the acronym those villages heavily infected by HIV/AIDS, and their re - GIPA. (53) This formula articulates the main principle behind pression of all those who question the official programmes, the operational mode of the NGO, enabling it to maintain there is still very little clarity about what concrete measures its independence, as well as the main thrust of its activities have been taken and their actual results, particularly in the in Taiwan and, as we shall see, in mainland China. remoter areas of the province. But this situation of system - Harmony Home has been able to benefit from a certain atic and more or less total obstruction by officialdom of the kind of publicity in Taiwan, since it has occasionally been an fight against HIV/AIDS in Henan has not prevented a object of attention in the island’s press, especially when transnational player like the Taiwanese NGO Harmony some HIV-positive individuals it was sheltering were threat - Home from intervening to foster a peasant-based response to ened with expulsion, or when its members deliberately let the contagion. This is indispensable if the province is to gen - themselves be arrested after attempting to steal bedding from uinely confront social consequences to which the authorities a department store in order to call attention to the lack of fi - have not yet responded adequately. nancial support for young children affected by the virus. This NGO has likewise enjoyed a high international profile com - The organisation and parable to its exposure in Taiwan, largely on account of its motivation of a transnational regular participation in numerous international demonstra - actor in the fight against AIDS tions addressing the HIV/AIDS problem, and its mainte - in Henan Province: The case of nance of a close and wide-ranging network of overseas con - Harmony Home tacts.

The morphology of a transnational actor The starting point and principal motives from Taiwan behind involvement in China

Although only registered with the Taiwanese Ministry of Harmony Home’s involvement dates back to 2003, and Public Affairs since 2003, Mrs. Yang and certain other since then it has been active in the provinces of Guangdong, members of the NGO known as Harmony Home ( guan'ai Guangxi, Yunnan, Shanxi, and Henan, where, depending zhijia xiehui ) have been engaged in the struggle against the on the local social and political situation and the support it social consequences of HIV/AIDS in Taiwan since 1997. Their activity is essentially focused on three main fronts: the 47. For an insight into the organisations in Taiwan struggling against AIDS, see Evelyne Micollier, “Emergence de la société civile à Taiwan, vers une gestion collective des prevention of HIV/AIDS, the fight against the discrimina - problèmes de santé,” in C. Chaîgne, C. Paix, C. Zheng (eds.), Taiwan: Enquête sur une tion faced by those infected, and support for HIV carriers in identité , Paris, Khartala (coll. “Hommes et Sociétés”), 2000, pp. 309-331; Vincent (47) Rollet, “Taiwanese NGOs and HIV/AIDS: From the National to the Transnational,” China their families. The prevention strategy adopted by Har - Perspectives , n. 60, 2005, pp. 16-29. mony Home depends mainly on organising information ses - 48. In this respect the important role played by Harmony Home should be emphasised, and sions in schools and other communities. The second front, in particular the petition it circulated in persuading the Taiwan government in July 2007 to promulgate the “Law on the protection of the rights of patients infected by HIV.” See the fight against discrimination, depends generally on http://www.cdc.gov.tw/public/Data/7121918211771.doc (consulted on 4 January demonstrations during which the organisation’s members 2009). plead with the public to understand the social limbo im - 49. By 2008, Harmony Home had opened four centres in Taipei (2), Kaohsiung, and Pingtung, receiving a total of 77 HIV positive people. posed on adults and children who have tested positive. With 50. A certain number of HIV positive people work in the flower shop opened by the NGO in the support of other local NGOs, they also call for the legal Taipei, and in enterprises in partnership with the organisation. protection of carriers in Taiwan to be strengthened. (48) Fi - 51. On several occasions this NGO has faced protests from residents or local officials in areas where the locations of their reception areas for positive carriers had been nally, Harmony Home provides practical support to those in - divulged. fected by providing lodging for men and women who are 52. “UN defends AIDS hospice,” Taipei Times , 31 January 2007, p. 3.

23 N o 2009/1 Special feature

Orphanage for children whose parents died of AIDS, Henan Province © Vincent Rollet s e v i a t has found, it has backed different projects for providing shel - c n i

e ter, meals, medical assistance, care, counselling, support, h p prevention, and training, often modelled on its work in Tai - s c r wan. The initial impetus for the extension of its activities into e

p China, and into Henan in particular, goes back to contacts made by its members, especially the woman who heads it, movement across the Taiwan Strait. If the number of HIV- when attending international conferences such as the AIDS positive carriers in China rises to a critical threshold, that sit - summit in 2001. This international gathering, attended for uation will have repercussions on the population of Taiwan. the first time by several Chinese activists in the fight against By emphasising this point, Harmony Home highlights the HIV, enabled Harmony Home to make initial contact and issue often raised at international conferences on infectious to gain firsthand information about the situation in China. diseases, namely the interdependence of security concerns Following this opening move, Harmony Home’s leader was shared by all societies in the face of the spread of such dis - invited by a group of HIV-positive activists to visit the main - eases, and it signals at the same time its willingness to take land and take part in some of their meetings, in the course part in the global struggle against epidemics. of which they advised the Taiwanese organisation to focus its activities on Henan. They took Mrs. Yang to the province The ways and means of in secret, so she could judge for herself the extent of the so - transnational intervention, cial repercussions of HIV infections there. and the building of a local Before going to China, Harmony Home had been working response to AIDS on a project to open a dispensary for terminally ill AIDS pa - tients, but following the visit by its leader to Henan, a new A strategy for strengthening the response priority arose: the protection of children who had lost their to AIDS at the village level parents to HIV/AIDS. On returning to Taiwan, in order to obtain funds from their international providers for this new Starting in 2003, and well aware of the extreme sensitivity venture in China, the members of the Harmony Home as - of the HIV/AIDS issue in Henan and of the additional sociation had its status as a Taiwanese NGO officially reg - problems facing a foreign NGO intervening in the most af - istered, and they started to consider the best ways of inter - fected villages in the province, Harmony Home focused its vening in China. intervention on supporting mutual aid among individual When the leader and members of Harmony Home are peasants and their families facing the consequences of the asked about their motives for becoming involved in the fight disease. In the case of the worst affected villages, this sup - against HIV/AIDS in China, the humanitarian motives that port took the indispensable form of vigorous initiatives to de - remain primary for their voluntary activities on the mainland velop community activities in which the main players would are accompanied by two more strategic perspectives. (54) The be the villagers themselves, and peasant HIV carriers in par - first concerns the organisation’s desire to expand internation - ticular. This approach, based essentially on the participation ally, both in terms of projects (in this regard, after China, of the whole village community, has led to three main proj - Africa seems to be its next field of activity) and in terms of ects aimed at reinforcing the villagers’ response to the AIDS financial backing. This is because by operating exclusively in epidemic. These have developed over the last five years, Taiwan until recently, the group was largely restricted to thanks to assistance from Harmony Home and the involve - funding from Taiwan; by opening up its field of activity into ment of the peasants from the province. Their main aim has China, however, it can hope to diversify its financial sources, been to compensate for the deficiencies in the provincial and especially to turn for support to the main international anti-HIV/AIDS programmes. providers of funds for the fight against HIV/AIDS. There is also a national security aspect to the arguments advanced 53. As ONUSAID points out, this “Great Involvement of People living with or affected by by this NGO’s members in justifying their involvement in HIV/AIDS,” formally adopted at the Paris summit on AIDS in 1994, is neither a pro - gramme nor a project but “a principle aimed at guaranteeing people living with HIV the China. Their speeches frequently reiterate the idea that epi - enjoyment of their rights and responsibilities, including the right of self-determination demics such as SARS, Avian flu, and AIDS represent a real and participation in the decision-making process affecting their lives.” See health threat to the population of Taiwan, particularly in http://www.unaids.org/fr/PolicyAndPractice/GIPA/default.asp. 54. From interviews with Mrs. Yang, leader of Harmony Home, and several other members, view of the rapid expansion of exchanges and individual conducted in Taipei on 20 November 2005, and 3 and 26 May 2006.

24 N o 2009/1 Village hospital, Henan Province © Vincent Rollet s e v i a The first of these projects addressed the need to organise a t c n i local response to the problem of orphans left by HIV/AIDS e h in a number of villages, particularly in Shenqiu County, p s c which has seen a large increase in the numbers left to fend r e

for themselves or to depend on their grandparents. It would p seem, moreover, that this county did not benefit from the at - most remote villages, many of these orphans have not in fact tention that the provincial authorities reserved for Shangcai been officially registered by an adult, and therefore do not and, as we have seen, for the village of Wenlou in particu - receive their due allowance. lar. According to many peasants from the neighbouring The second of these projects is aimed at giving peasants ef - county, the latter village was turned into a showcase for the fective means of dealing with the recurrent problem of the central government and foreign agencies in order to demon - abandonment of AIDS treatments, and the consequent risk strate that local authorities had really taken charge of the of increased resistance to the antiretroviral drugs. In fact, HIV/AIDS problem and its orphans. (55) So in late 2003, in while it is undeniable that since 2004 the provincial author - one of these remote villages in Shenqiu County, (56) where a ities have built a certain number of clinics in Henan’s vil - large number of tombs rising like small mountains amidst the lages (the village in Shenqiu County mentioned earlier has fields shows how severely the AIDS virus has struck its in - actually had one since 2005), and that they have given large habitants, the Taiwanese organisation contributed to open - amounts of antiretroviral drugs to thousands of AIDS suffer - ing a reception centre for AIDS orphans. After a careful ers, there are still a number of challenges to be overcome search for trustworthy local partners to manage this project, that seem to require the involvement of the peasants them - Harmony Home made an arrangement with a peasant cou - selves. Among these challenges two in particular stand out. ple who agreed to shelter and feed about 20 orphans in their The first of these is the increasingly frequent abandonment home. by HIV-positive peasants of their combination therapies Subsequently, Harmony Home’s principal role became that after several years of treatment. There are two reasons for of providing funds for this reception centre. In fact, within this. The first is the side effects of the treatment. While the the framework of its “Food for Hope” programme, which Chinese government, in pursuit of its “Four Frees and One currently covers 1,000 orphans, the organisation provides Care” programme, bought six first-generation antiretroviral 130 yuan for each child enrolled, to which, as we have seen, drugs (57) (which are now produced as generic drugs in China since April 2004, the provincial government has added an itself), and this enabled courses of treatment to be set up at equal amount intended mainly for the orphans’ basic needs one twentieth of the cost of courses using second-generation and education. While Harmony Home retains the role of antiretroviral drugs, (58) the drawback has been reputedly both supervisor and producer of the annual report to donors, painful side effects that lead many HIV-positive patients to the daily running of the centre rests entirely with the village abandon their treatment. couple, assisted by several peasants, some of whom are In addition, there is a severe lack of medical personnel for HIV-positive and others not. In this way, they are the ones this programme in the Chinese countryside. The opening who ensure the safety of the children, their health, their years of this official initiative were marked by laxity in the school attendance, and their daily lives, and provide conso - way the antiretroviral drugs were prescribed for the peasants, lation for bereavement when needed. All of this takes place due to the inadequate training of the young doctors working in a family atmosphere where freedom, respect, and the in the newly built clinics. Lacking instructions on how to right of each child to be heard are vigorously defended. take the antiretroviral drugs, for several years the peasants According to the peasants participating in this project, such were free to take them as they felt inclined, with a resulting an atmosphere is not to be found in the official orphanages, risk that they would not follow the treatment correctly and and this has inspired Harmony Home to seek to open more would eventually abandon it. Although the doctors in these reception centres in the county. It should be emphasised that these villagers have also undertaken the task of informing the 55. Interviews with several villagers from Shenqiu County, in May 2006 and June 2007. orphans’ grandparents, or others who have taken them in, of 56. In accordance with a request from Harmony Home, the name of this village has been the importance of enrolling them on the official register of omitted. AIDS orphans in order to receive the government subsidies 57. Zidovudine, Didanosine, Nevirapine, Stavudine, Efavirenz, and Lamivudine. 58. A year’s treatment using second generation antiretroviral drugs would cost the govern - mentioned earlier. Because of the lack of information in the ment 20,000 yuan per patient.

25 N o 2009/1 Special feature s e v i a t clinics are better trained nowadays, particularly in Shenqiu several of his HIV-positive relatives. (62) These annual train - c n i

e County, their numbers and those of nurses trained in AIDS ing sessions are attended by around 15 peasants from vari - h p treatment are lower than required to meet the needs of all ous counties in Henan, who then return to their villages with s c r the HIV-positive patients and to provide adequate follow-up the means to act effectively in their communities and be - e

p care. Their ability to make proper AIDS diagnoses, to estab - yond. lish a suitable antiretroviral regimen for each patient, or to The role of these trained peasants is twofold. Firstly, they follow the developments of the virus in HIV-positive carri - make weekly visits to peasants undergoing antiretroviral ers, is still extremely limited. As a result, in many of the vil - treatments in the clinics or at home, in order to give expla - lages in Shenqiu County, HIV-positive peasants undergoing nations or reminders of the importance of taking their med - treatment are still not receiving close and effective monitor - icines, and of the proper way to take them. They also give ing of their illness. In many extreme cases, patients severely moral support and listen to patients who are having particu - weakened by the disease have even chosen to remain at lar difficulty with side effects. Second, but equally impor - home, where at least there is some support, rather than stay - tant, is the support these visits provide to family members, ing in a clinic where they receive treatment but not the nec - allowing them not to feel completely isolated in the face of essary care or follow-up. It is not unusual to come across vil - their relatives’ suffering, and providing them with the tools lage clinics without any of the patients for whom they were to keep their relatives from abandoning treatment in antici - originally built, and to find these same AIDS sufferers at pation of a less burdensome antiretroviral regimen. (63) On home by themselves or helped by a partner. This increases their return from training, it is up to these peasants them - the risk of treatment being abandoned. Although there are selves to set up a local mutual aid network (often under the no official statistics on the abandonment of the prescribed name of an association), and to pass on their training to the combination therapies among the peasants of Henan, some inhabitants of their village and neighbouring villages. They doctors from Zhengzhou and Shenqiu County believe the also make visits, to the extent possible, to support the sick. figure to be around 40 percent and even higher in some vil - Interviews in Shenqiu County with many patients undergo - lages. (59) ing antiretroviral treatment and their relatives confirm the The inappropriate way of taking medicine, and the abandon - need, and in many cases, the real effectiveness, of this kind ment of combination therapies, feed into the second prob - of mutual help at the village level. This group of village ac - lem facing official AIDS treatment programmes, namely re - tivists then went on to assist in the official registration of sistance to treatment. For several years in the Chinese coun - HIV-positive peasants, enabling them to benefit from gov - tryside there has been a growth in cases of resistance to the ernment allowances and free treatment. They also offered first generation of antiretroviral drugs, which are virtually the free AIDS detection to peasants who had sold their blood only weapons currently available to doctors for the treatment in the past, with the help of kits supplied by the Taiwanese of Henan’s peasants. Whereas official reports put the cases NGO, and they continued to publicise the need for free of patients developing resistance to the antiretroviral drugs at blood donation at a time when health authorities acknowl - 17 percent, (60) doctors working in the Henan countryside put edged that payment for blood donations was still ongoing in the figure at 50 percent. China. (64) Given this situation, in order to give HIV-positive peasants Support for the villagers’ response to AIDS in Shenqiu the knowledge and tools necessary to deal with problems County takes the form of a third project aimed at making that could potentially undermine the whole fight against HIV/AIDS in Henan, Harmony Home launched a training 59. From a meeting with two doctors from villages in Shenqiu County and one based in programme in primary care, the proper taking of antiretrovi - Zhengzhou. ral drugs, counselling, and patient follow-up. These two-day 60. State Council AIDS Working Committee Office, UN Theme Group on AIDS in China, A Joint sessions in the town of Dengfeng were designed by Har - Assessment of HIV/AIDS Prevention, Treatment and Care in China (2007) , 1 December mony Home in collaboration with AIDS Care China and 2007, p. 25. 61. He is about 30 years old, and has been involved for five years in Harmony Home’s AIDS Alliance, and they were then organised on the spot activities in his native Taiwan in the field of training and providing shelter for HIV-posi - by the head of their mission in Henan, who is HIV-positive tive people. (61) 62. This 40-year-old pharmacist’s involvement goes back to the earliest days of Harmony and comes from Taiwan, and by a Zhengzhou resident Home’s presence in Henan. who is a trained pharmacist and whose involvement in the 63. This point is generally made by relatives of HIV-infected people. struggle against HIV/AIDS was motivated by the death of 64. “China says it faces threat from illegal blood sales,” China Daily , 14 June 2007.

26 N o 2009/1 HIV-infected villagers are trained to breed rabbits © Vincent Rollet s e v i a this response fully independent by giving it control over its t c n i own income. Drawing inspiration from the experience of e h Harmony Home in Taiwan, and particularly from its estab - p s c lishment of a flower shop there, the project’s co-ordinator in r e

Henan and his local colleague have drawn up a plan for eco - p nomic independence through productive activity ( shengchan 2004 the organisation decided to open an office in an apart - zijiu ). In this instance, they are involved in rabbit breeding, ment in Dengfeng. This place serves as the organisation’s the stewardship of which will be handed over to HIV-posi - base camp in Henan, being its administrative centre and res - tive volunteers from 2009 onwards. This initiative, financed idence for its co-ordinator, and it also operates as a reception by Harmony Home, will enable some peasants to return to centre for HIV-positive peasants passing through the town. the kind of social activity that is often lost as a result of As we have noted earlier, the lack of medical resources in AIDS affecting their physical and mental health. The sale the countryside, particularly in terms of care and patient fol - of the animals raised will also in due course provide a finan - low-up, has encouraged the organisation to seek out estab - cial basis for further activities in the struggle against the lishments and doctors in the towns willing to provide consul - repercussions of the HIV/AIDS outbreak in the village and tations, counselling, and follow-up treatment to any peasant beyond. The field of productive activity chosen for this proj - carriers who seek their help. This means that the peasants ect was largely the result of a promise of support from a rab - get the benefit of tests (CD4), diagnoses, and the type of bit breeder who manages a farm raising a thousand such an - care that is extremely limited in the countryside. The costs imals just a few miles from the village. This manager, who of these medical interventions are met by Harmony Home. has lost several of his relatives and employees to the AIDS In order to reduce as much as possible the expense of these virus, has agreed to help NGO activists and villagers to set town visits for infected villagers, Harmony House puts beds up their project for economic independence in the fight and clean facilities at their disposal, provides meals during against HIV/AIDS, and to play a leading role in ensuring their stay, and subsidises their transport costs. It also pro - the smooth running and durability of this initiative. vides a place for receiving and sharing information on the The manager has undertaken to sell several breeding pairs developing health situation of the AIDS patients. By fulfill - very cheaply to Harmony Home, and thereby to the future ing the role of intermediary between the peasants and the breeders, along with the equipment needed to raise the ani - urban medical institutions, and especially by enabling a close mals. He has also promised to provide several training ses - follow-up of the patients, this centre represents an additional sions, including a visit to his farm, to buy the progeny from tool in the fight against the abandonment of AIDS treat - the villagers, and to sell them for their fur and meat to his ment, which remains one of the main problems in the coun - customers throughout Henan Province and beyond. This tryside. project is supported by three main players: Harmony Home provides the investment, the village volunteers are the pro - Intervention with discretion ducers, and the professional breeder acts as buyer and mid - dle man. According to those in charge, it should be a prof - The support provided by this Taiwanese NGO for the mo - itable enterprise, able in the longer term to provide ample bilisation of the peasantry against the ravages of support, or even a principal resource, for the various strug - HIV/AIDS in Henan should not make us forget that the gles against AIDS to be mounted in this village in Shenqiu. issue remains very sensitive in the province. As emphasised Such activities can then be replicated to produce still more above, the local and provincial authorities maintain a policy independence. of tight control over information about HIV, and over the or - ganisation of the response to AIDS. But in the face of the A relay to enable access to health services breadth and gravity of the situation, there is still a lot to be done, and the authorities cannot provide an effective overall Along with strengthening the mobilisation of several of the response on their own. Intervention by various associations villages in Shenqiu County, Harmony Home also seeks to and the increased involvement of HIV-positive individuals make health provisions more easily available to HIV-positive themselves have become unavoidable. This raises the whole peasants. Because numerous medical resources, both human question of the relationship between officialdom and the and material, are concentrated in the provincial towns, in people active in the civil mobilisation against AIDS.

27 N o 2009/1 Special feature s e v i a t In the case of Harmony Home’s intervention in China, this property, might turn against the location of such a centre on c n i

e issue is particularly difficult, and it is given careful consider - their doorstep, the organisation has exercised the greatest h p ation by its members in Taiwan and Henan alike. While for possible discretion as it opens its doors, receives HIV-posi - s c r obvious reasons this intervention was kept secret for a while, tive peasants, and works with its network of supportive doc - e

p it is now rather more a matter for discretion, being presented tors. as merely complementary to local official activities. Indeed, Although the official approach to the fight against Harmony Home has chosen not to criticise the local author - HIV/AIDS is not favourable to foreign aid, Harmony ities for their failure to respond to the social repercussions of Home has been intervening since 2003, especially in the vil - the disease, and not to add their voice to the protests from lages most afflicted by the virus. It has developed a way of the villagers (such as demands for compensation, or improv - conducting itself specifically adapted to Henan around four ing access to care facilities), but rather to help the peasants principles. The first is that people living with HIV/AIDS to help themselves through the provision of funding or train - should become more involved in their community’s response ing, and thereby reducing the impact of these failures on the to the repercussions of the disease. This response is then population. supported and strengthened by the NGO through a small As for the Henan authorities, after forbidding every local but necessary financial contribution and by training sessions initiative at first, they now seem prepared to accept those that enable the mobilised peasants to provide a viable and that do not directly or openly call official measures into ques - lasting response to the needs of AIDS sufferers and their tion. Nonetheless, foreign interventions are still fraught with families. The second principle follows as a consequence of difficulties. That is why, in the light of the failures experi - this peasant-centred approach, namely that the progressive enced by other transnational players in Henan, Harmony achievement of independence for this response is absolutely Home, at least at the local level, has reduced to a minimum indispensable if it is to last. The third principle is the ab - the visible links between itself on the one hand, and its re - solute respect for the rights of HIV patients enrolled in the ception centre project and the village mutual help groups on different plans in China for the fight against AIDS. For this the other, seeking to further promote the independence of NGO, the defence of this principle comes down to facilitat - their local initiatives. Thus, in the village in Shenqiu County, ing the access of HIV-positive peasants and their families to the reception centre is extolled by local political and health the care provisions and subsidies to which they are entitled. authorities, who present this expression of the village com - Lastly, the fourth principle governing Harmony Home’s ac - munity’s sympathy for AIDS orphans as though it were a re - tivities in Henan is discretion. This is characterised by the sponse to the national policy promoting the adoption of such refusal to criticise local officials openly, and by a complete children by volunteer families. This does not prevent the po - self-effacement behind the peasants to prevent the authori - lice and militia from keeping a strict watch over the recep - ties considering the various projects as instances of foreign tion centre and the doings of its HIV-positive peasant ac - interference in local affairs. Thanks to these specific forms tivists, who have become used to being interrogated about of action, which could well serve as a model to other transna - their activities. It is also worth pointing out the harassment tional agencies wishing to bring their help to the province, dealt out to a sociology professor from a university in the this Taiwanese NGO has managed to stimulate, support, province when he came to the centre to meet and interview and reinforce the peasant response to HIV/AIDS. Taken HIV-positive villagers in order to study their situation since together, all this activity constitutes a valuable and dynamic the inception of the “Four Frees and One Care” policy. approach to the numerous social challenges that this disease Such examples show the care taken by the local authorities has inflicted upon the worst affected villages in Henan.• to ensure that all initiatives undertaken by the population should be contained and prevented from leading to any chal - • Translated by Jonathan Hall lenge to their power. They also show how right Harmony Home is to be discrete in its work, since the training of HIV- positive villagers and the very existence of a reception cen - tre in Dengfeng could be affected. Fearing that the officials Glossary in charge of the town of Dengfeng might refuse to accept simian yi guanhuai 四免 一 關懷 this kind of service, or that the centre’s neighbours, fright - guan'ai zhi jia xiehui 關愛 之家 協會 ened of HIV contamination and a fall in the value of their shengchan zijiu 生產 自救

28 N o 2009/1